IVF implants reduced for safety

By Chiang Sheng 江盛

The Taiwanese Society for Reproductive Medicine (TSRM) recently announced new clinical guidelines recommending that the number of embryos implanted during fertility treatments be limited to a maximum of two.

Current regulations on artificial insemination allow for the placement of up to five embryos, while directives from the Department of Health’s Bureau for Health Promotion recommended only four.

A physician and former chairman of the Taiwan Association of Obstetrics and Gynecology, Lee Maw-sheng (李茂盛), has pointed out that, prior to the TSRM’s announcement, certain clinics were placing more than 10 embryos during such procedures. He added that he had also done so in the past, and on one occasion all 10 took, obliging the patient to go through three selective abortion operations to address the multiple pregnancy. Even then the woman gave birth to twins.

What are the pros and cons of adjusting the practice of implanting 10 or more embryos down to the current limit of four and further lowering that number to two?

About three years ago, the Taichung District Court ordered a specialist in that city to pay compensation of NT$510,000 (US17,000) to a surrogate mother because the specialist’s artificial insemination procedure had left the woman pregnant with eight embryos. This multiple pregnancy led to severe vomiting and high blood pressure in the patient, who ultimately had to go through six reduction abortion operations, resulting in a uterine infection and caused a miscarriage, which almost killed her. In addition, it is unlikely that she would be able to get pregnant again.

Artificial insemination is a competitive field, worth billions of New Taiwan dollars, and is rife with all kinds of methods to increase fertility, a wide range of prices, confidentiality surrounding the number of embryo implants a woman has, promises of pregnancy and live birth rates, and the initial euphoria of success often ending in disappointment from an early miscarriage.

Infertility clinics worldwide are looking into new ways to increase the success rate for test-tube babies, directing efforts at controlling lab conditions or improving placement techniques, each claiming that they are more successful than the other. The reality is that there is very little to distinguish one specialist from another in terms of success rates, and members of the public have no means to make informed choices on which practitioner to use.

The private artificial insemination market in Taiwan is essentially a small, exclusive club of infertility experts, all of whom claim they can create life, but who remain tight-lipped when it comes to the problem of having to carry out selective abortions in the event of multiple pregnancies occuring. Nor are they entirely transparent about the realities of the process, not mentioning the multiple pregnancies that can occur, which expose women to health risks, or of the possibility of premature births.

Taiwanese fertility specialists have often been criticized for claiming impressive success rates while failing to observe the conventions followed in other countries, which limit the number of embryos implanted during the procedure to two.

With a younger generation of doctors, the TSRM has moved beyond such outdated ideas, hence these latest clinical guidelines, which can be seen as a form of reproductive justice for women.